DENIAL CODES

Denial code N367

Remark code N367 indicates a claim has been sent to a Consumer Spending Account processor, such as an FSA or HSA, for review.

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What is Denial Code N367

Remark code N367 indicates that the claim information has been forwarded to a Consumer Spending Account processor for review, such as a flexible spending account or health savings account.

Common Causes of RARC N367

Common causes of code N367 are incorrect or incomplete submission of claim details pertinent to Consumer Spending Accounts (CSAs) such as Flexible Spending Accounts (FSA) or Health Savings Accounts (HSA), submission of claims for services not covered under the patient's CSA, or discrepancies in the patient's account information that necessitate further review by the CSA processor. Additionally, this code may be triggered by the submission of claims that exceed the available balance in the patient's CSA or by the lack of necessary documentation to support the claim's eligibility under the CSA guidelines.

Ways to Mitigate Denial Code N367

Ways to mitigate code N367 include implementing a thorough review process for identifying and separating claims that are eligible for Consumer Spending Account (CSA) processing from regular insurance claims before submission. This involves training billing staff to recognize services and procedures that are typically covered by flexible spending accounts (FSAs) or health savings accounts (HSAs) and ensuring they are familiar with the latest updates on eligible expenses. Additionally, adopting advanced billing software that can automatically flag potential CSA-eligible claims based on service codes can streamline this process. Establishing direct communication channels with CSA processors to quickly resolve any issues or questions regarding claim eligibility can also prevent delays and improve the accuracy of claim submissions. Lastly, encouraging patients to regularly update their billing information, including their CSA details, can help in accurately directing claims to the appropriate processor from the outset.

How to Address Denial Code N367

The steps to address code N367 involve a multi-faceted approach to ensure the claim is processed correctly and efficiently. First, verify the details of the claim to ensure all information is accurate and complete, focusing on the dates of service, procedure codes, and billed amounts. Next, contact the patient to confirm their Consumer Spending Account (CSA) details, including the account type (e.g., FSA or HSA) and the administrator's contact information. It's also crucial to inquire if the patient has submitted the claim to their CSA or if they intend for the provider to do so.

Following patient confirmation, reach out to the CSA processor directly to verify receipt of the claim information and understand any specific requirements or additional documentation they might need for processing. If the claim has not yet been submitted to the CSA, prepare and send the necessary documentation, ensuring to follow the CSA's submission guidelines closely.

Monitor the claim's status with the CSA processor regularly and maintain open communication lines with the patient regarding any updates or additional information required. Should the CSA processor reject or partially pay the claim, review their explanation carefully, address any issues, and resubmit the claim if necessary.

Finally, once the CSA has processed the claim, update the patient's account accordingly, and if there's a balance not covered by the CSA, bill the patient or their primary insurance as per the standard billing procedure. Throughout this process, document all communications and steps taken to provide a clear audit trail and facilitate any future inquiries or appeals.

CARCs Associated to RARC N367

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